Healthcare Provider Details

I. General information

NPI: 1972426617
Provider Name (Legal Business Name): ALISIA MARIE BRUNSON HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W GENESEE ST STE 3
SYRACUSE NY
13204-2329
US

IV. Provider business mailing address

113 CHEERWOOD DR
BALDWINSVILLE NY
13027-3318
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-0600
  • Fax:
Mailing address:
  • Phone: 315-447-5756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: